Business Process Product Development
Resume:
Kim Johns
Director of Business Process
Seeking a position where I can maximize
my 10+ years of management, quality
assurance, product development,
consulting, and training expertise.
Experience Education
2023- Current
Director of Business Process United Healthcare
Configuration subject matter expert in Dental Facets, including core pricing and benefit configuration.
Creation of written business process documents.
Resolution of issues both in relation to provider and members claims and configuration.
Work with all areas where Facets impacts both upstream and downstream. Where there are issues work with those areas to come up with the best solutions that we are trying to resolve.
Testing solutions out to ensure that the configuration is working as designed.
2018 - 2023
Director of Product Development Optum
Utilizing agile methodology managing the claims and configuration scrum teams for our Core MMIS product offering, and both South Carolina and Montana
implementations.
Worked as a Product Owner refining the requirements for the configuration and claims scrum teams.
Manage the review of core objectives for the product and road mapping them for each year.
Release management for all Facets environments and MT provider environments ensuring the development and 2000 – 2002
Bachelors of Science
University of Utah
1998 – 2000
Associate of Science
Salt Lake Community College
Skills
Project Management
Leadership
Organized
Problem Solving
Teamwork
Agile focused
SQL Queries
Access Queries
Intermediate Excel
Contact
4855 W Mountain Hill Dr
West Jordan, UT 84081
**********@*****.***
configuration get into the appropriate environments.
As the Facets owner and subject matter expert worked to engage other system owners to ensure that the data that feeds into our other systems are mapped correctly. This includes provider, member, portals, and financial data management systems.
Worked as the liaison with our vendor Cognizant.
Manage the department contractors with two different vendors. Reviewing their time, contracts, and extension approvals.
Managed resources in both the Claims and Configuration scrum teams both onshore and offshore. Coaching the members of the team on personal development and
performing performance reviews.
2014 – 2018
IT Senior System Analyst Optum
Design solutions for both development and configuration for implementations and expansion projects in CSP Facets using waterfall technology.
Claims development and configuration subject matter expert on Medicaid, CHIP, Medicaid Waiver programs, and Medicare in Facets.
Creation of training and process documentation for the Claim Development team.
Mentoring of new employees and contractors in the System Analyst role as well as getting them acquainted with the department development processes.
Management of project inventory for the Claims Domain staff.
Management of Project hours ensuring that there are no discrepancies in the reporting.
2011 – 2014
Configuration Architect Manager - United Healthcare
Manage up to twenty-five people in benefit and pricing configuration for three different platforms including Diamond, COSMOS, and CSP Facets.
Manage inventory and assignment of work for all benefit configuration staff.
Project management of Medicaid expansion projects for the benefit configuration team.
Project management of the ICD-10 project for Facets.
Creation of training process documents to assist new hires and existing employees to get familiar with configuration in Facets.
Mentoring of staff on Facets configuration both on and off my team.
Managed the governance approval process for configuration review and provided approval of configuration summaries for the department to ensure that platform standards were being followed.
Management of configuration audits received from BPQM, to ensure that there is supporting evidence for the configuration that was completed or initiating the correction of Facets.
Claims and configuration subject matter expert on Medicaid, CHIP, Medicaid Waiver programs, and Medicare.
Architect and design configuration solutions for complex builds. 2009 – 2011
Senior IT Business Analyst - United Healthcare
Implementation of Facets for Medicaid line of business.
Facets configuration of Pricing and benefits and testing of the configuration to ensure that it meets the requirements.
Extraction of data and researching defects through queries to aid in the development and correction of Facets.
Project management of Diamond system implementation into CSP Facets.
Benefit configuration and timely filing rules in the Diamond system.
Creation of process documents to support the training of the team.
Training of Facets pricing and benefit configuration.
Assisted in the success of the Maryland Diamond conversion to Facets. 2007 – 2009
Dispute Resolution Analyst - Ingenix (Optum360)
Extraction of product data and researching information through queries in SQL.
Research legal cases and help provide evidence to support defendants in legal proceedings.
Creating statistical analysis and graphs for use as evidence in legal proceedings. 2006 – 2007
Implementation Consulting Specialist - First Consulting Group
Creation of Product and Plan benefit configuration in Facets and how it affects claims processing.
Extracting data and researching information found through queries in Microsoft Access to aid in development and corrections of Facets.
Creation of project documentation to support implementations.
Provider and Facility contractual analysis and configuration into Facets.
Project management consultant on the implementation of Facets and system updates. 2001 – 2006
Configuration Analyst - SelectHealth
Project management of different commercial insurance products and provider arrangements that needed to e configured into the Facets system.
Extracting data and researching information found through queries in Microsoft Access to aid in development and corrections of Facets.
Configuration of complex provider contractual agreements in Facets.
Training of Facets pricing configuration and provider and facility set up in Facets.
Creation of training documents.
Configuration of Product and plans to support member commercial offerings.
Management of authorization requirements within Facets configuration. 1994 – 2001
Health Benefit Specialist - SelectHealth
Knowledge of all commercial plans and processes needed to process claims.
Processing of all specialty service claims.
A leader of the team processed payroll, meeting attendance for specialty claims processing and projects, handling manager calls from members.
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